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Thursday, December 18, 2008

A team of eight transplant surgeons in Cleveland Clinic in Ohio, USA, led by reconstructive surgeon Dr. Maria Siemionow, age 58, have successfully performed the first almost total face transplant in the US, and the fourth globally, on a woman so horribly disfigured due to trauma, that cost her an eye. Two weeks ago Dr. Siemionow, in a 23-hour marathon surgery, replaced 80 percent of her face, by transplanting or grafting bone, nerve, blood vessels, muscles and skin harvested from a female donor’s cadaver.

The Clinic surgeons, in Wednesday’s news conference, described the details of the transplant but upon request, the team did not publish her name, age and cause of injury nor the donor’s identity. The patient’s family desired the reason for her transplant to remain confidential. The Los Angeles Times reported that the patient “had no upper jaw, nose, cheeks or lower eyelids and was unable to eat, talk, smile, smell or breathe on her own.” The clinic’s dermatology and plastic surgery chair, Francis Papay, described the nine hours phase of the procedure: “We transferred the skin, all the facial muscles in the upper face and mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw including the teeth, the facial nerve.” Thereafter, another team spent three hours sewing the woman’s blood vessels to that of the donor’s face to restore blood circulation, making the graft a success.

The New York Times reported that “three partial face transplants have been performed since 2005, two in France and one in China, all using facial tissue from a dead donor with permission from their families.” “Only the forehead, upper eyelids, lower lip, lower teeth and jaw are hers, the rest of her face comes from a cadaver; she could not eat on her own or breathe without a hole in her windpipe. About 77 square inches of tissue were transplanted from the donor,” it further described the details of the medical marvel. The patient, however, must take lifetime immunosuppressive drugs, also called antirejection drugs, which do not guarantee success. The transplant team said that in case of failure, it would replace the part with a skin graft taken from her own body.

Dr. Bohdan Pomahac, a Brigham and Women’s Hospital surgeon praised the recent medical development. “There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Leading bioethicist Arthur Caplan of the University of Pennsylvania withheld judgment on the Cleveland transplant amid grave concerns on the post-operation results. “The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell. If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying. There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Dr Alex Clarke, of the Royal Free Hospital had praised the Clinic for its contribution to medicine. “It is a real step forward for people who have severe disfigurement and this operation has been done by a team who have really prepared and worked towards this for a number of years. These transplants have proven that the technical difficulties can be overcome and psychologically the patients are doing well. They have all have reacted positively and have begun to do things they were not able to before. All the things people thought were barriers to this kind of operations have been overcome,” she said.

The first partial face transplant surgery on a living human was performed on Isabelle Dinoire on November 27 2005, when she was 38, by Professor Bernard Devauchelle, assisted by Professor Jean-Michel Dubernard in Amiens, France. Her Labrador dog mauled her in May 2005. A triangle of face tissue including the nose and mouth was taken from a brain-dead female donor and grafted onto the patient. Scientists elsewhere have performed scalp and ear transplants. However, the claim is the first for a mouth and nose transplant. Experts say the mouth and nose are the most difficult parts of the face to transplant.

In 2004, the same Cleveland Clinic, became the first institution to approve this surgery and test it on cadavers. In October 2006, surgeon Peter Butler at London‘s Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out a full face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals. In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.

Ethical concerns, psychological impact, problems relating to immunosuppression and consequences of technical failure have prevented teams from performing face transplant operations in the past, even though it has been technically possible to carry out such procedures for years.

Mr Iain Hutchison, of Barts and the London Hospital, warned of several problems with face transplants, such as blood vessels in the donated tissue clotting and immunosuppressants failing or increasing the patient’s risk of cancer. He also pointed out ethical issues with the fact that the procedure requires a “beating heart donor”. The transplant is carried out while the donor is brain dead, but still alive by use of a ventilator.

According to Stephen Wigmore, chair of British Transplantation Society’s ethics committee, it is unknown to what extent facial expressions will function in the long term. He said that it is not certain whether a patient could be left worse off in the case of a face transplant failing.

Mr Michael Earley, a member of the Royal College of Surgeon‘s facial transplantation working party, commented that if successful, the transplant would be “a major breakthrough in facial reconstruction” and “a major step forward for the facially disfigured.”

In Wednesday’s conference, Siemionow said “we know that there are so many patients there in their homes where they are hiding from society because they are afraid to walk to the grocery stores, they are afraid to go the the street.” “Our patient was called names and was humiliated. We very much hope that for this very special group of patients there is a hope that someday they will be able to go comfortably from their houses and enjoy the things we take for granted,” she added.

In response to the medical breakthrough, a British medical group led by Royal Free Hospital’s lead surgeon Dr Peter Butler, said they will finish the world’s first full face transplant within a year. “We hope to make an announcement about a full-face operation in the next 12 months. This latest operation shows how facial transplantation can help a particular group of the most severely facially injured people. These are people who would otherwise live a terrible twilight life, shut away from public gaze,” he said.

Sunday, February 7, 2010

A major winter storm, which has been nicknamed by some as “Snowmageddon“, has pummeled parts of the U.S. Middle Atlantic region, dumping up to 19 inches (50 centimeters) of snow in some parts of the Washington area.

The National Weather Service is predicting as much as 24 to 30 inches (60 to 75 cm) of snow for the Washington, D.C. region by late Saturday. The storm brought high winds and low visibility, with winds gusting at 56 miles per hour (93 kilometers per hour) along the coast.

Life in the nation’s capital ground to a halt with the federal government and most businesses closing early on Friday and residents warned to stay off the snow-clogged roads. Hundreds of thousands of homes were without power as the wet snow weighed heavily on trees and power lines. Power lines in some areas have been brought down by the heavy snow.

The Weather Service issued blizzard and winter storm warnings for states reaching from Virginia and West Virginia up to Maryland, Pennsylvania, Delaware, and New Jersey.

Forecasters say this could be the largest recorded snowfall in Washington, rivaling a storm, known as the Knickerbocker Storm, that hit the city nearly 90 years ago, in January 1922. The largest amount of snowfall recorded so far has been in Elkridge, Maryland, reporting 32 inches (81 cm). The 1922 storm was named the Knickerbocker Storm for a theater where 98 people were killed when the building’s roof collapsed due to heavy snow. Snowfall in that storm measured 28 inches (71 cm).

Airlines and airports across the region have canceled flights and train service has been disrupted. Ronald Reagan Washington National Airport suspended flight operations for the day while nearby Washington Dulles International Airport reported only a few international flights would be departing. Baltimore/Washington International Thurgood Marshall Airport reported most flights were canceled. Flights at Philadelphia International Airport are also canceled.

Amtrak announced that it was canceling a number of trains between Washington and New York City, along with service from Washington to cities in the south. The Washington Metropolitan Area Transit Authority, known as the Metro locally, has suspended bus service and above ground train service. Underground subway service is running at 30 minute intervals.

As the storm approached, residents emptied supermarket shelves, stocking up on food and other supplies, especially due to Super Bowl XLIV which will be held on Sunday. Local area sports teams in Washington, D.C. will still play games as scheduled. People are urged to take the Metro to see the games and not use the roads. Impromptu snowball fights have also broken with some people going as far as to organize them over Facebook and Twitter.

The winter weather has already been blamed for hundreds of road accidents. So far two fatalities have been reported, a father and son who were rendering aid to a stranded motorist on Interstate 81 in Virginia, when an approaching tractor-trailer jackknifed and killed the pair.

This is the second major snowstorm to hit the region in less than two months.

Monday, June 21, 2010

Sweden’s first royal wedding since 1976 took place Saturday when Crown Princess Victoria, 32, married her long-time boyfriend and former personal trainer, Daniel Westling, 36. The ceremony took place at Stockholm Cathedral.

Over 1,200 guests, including many rulers, politicians, royals and other dignitaries from across the world, attended the wedding, which cost an estimated 20 million Swedish kronor. Victoria wore a wedding dress with five-metre long train designed by Pär Engsheden. She wore the same crown that her mother, Queen Silvia, wore on her wedding day 34 years previously, also on June 19. Victoria’s father, King Carl XVI Gustaf, walked Victoria down the aisle, which was deemed untraditional by many. In Sweden, the bride and groom usually walk down the aisle together, emphasising the country’s views on equality. Victoria met with Daniel half-way to the altar, where they exchanged brief kisses, and, to the sounds of the wedding march, made their way to the the silver altar. She was followed by ten bridesmaids. The couple both had tears in their eyes as they said their vows, and apart from fumbling when they exchanged rings, the ceremony went smoothly.

Following the ceremony, the couple headed a fast-paced procession through central Stockholm on a horse-drawn carriage, flanked by police and security. Up to 500,000 people are thought to have lined the streets. They then boarded the Vasaorden, the same royal barge Victoria’s parents used in their wedding, and traveled through Stockholm’s waters, accompanied by flyover of 18 fighter jets near the end of the procession. A wedding banquet followed in the in the Hall of State of the Royal Palace.

Controversy has surrounded the engagement and wedding between the Crown Princess and Westling, a “commoner”. Victoria met Westling as she was recovering from bulemia in 2002. He owned a chain of gymnasiums and was brought in to help bring Victoria back to full health. Westling was raised in a middle-class family in Ockelbo, in central Sweden. His father managed a social services centre, and his mother worked in a post office. When the relationship was made public, Westling was mocked as an outsider and the king was reportedly horrified at the thought of his daughter marrying a “commoner”, even though he did so when he married Silvia. Last year, Westling underwent transplant surgery for a congenital kidney disorder. The Swedish public have been assured that he will be able to have children and that his illness will not be passed on to his offspring.

Westling underwent years of training to prepare for his new role in the royal family, including lessons in etiquette, elocution, and multi-lingual small talk; and a makeover that saw his hair being cropped short, and his plain-looking glasses and clothes being replaced by designer-wear.

Upon marrying the Crown Princess, Westling took his wife’s ducal title and is granted the style “His Royal Highness”. He is now known as HRH Prince Daniel, Duke of Västergötland. He also has his own coat-of-arms and monogram. When Victoria assumes the throne and becomes Queen, Daniel will not become King, but assume a supportive role, similar to that of Prince Phillip, the husband of the United Kingdom’s Queen Elizabeth II.

Tuesday, August 15, 2006

Former Israeli prime minster Ariel Sharon, 78, has developed double pneumonia and is being treated with “massive” amounts of antibiotics according to hospital officials.

“We are talking about pneumonia that is being treated with massive antibiotics. There is no change in the functioning of the brain tissue and no significant fall in vital signs,” said officials at Tel Hashomer hospital in the Sheba Medical Center located in Tel Aviv, in a statement today.

Yesterday doctors stated that Sharon’s urine ouput had “decreased significantly” and that a scan of his brain “showed a deterioration in his brain function,” said Anat Dolev, a Sheba Medical Center spokesman.

Yesterday the hospital reported that the condition of Sharon was getting worse.

Sharon has been in a coma since suffering a major stroke on January 4. Since being admitted to the hospital, he has undergone several rounds of surgery on his brain in an attempt to stop bleeding. Currently a respirator assists him in breathing.

Thursday, June 12, 2008

A major storm suspected to be a tornado has reportedly killed four Boy Scouts camping at the Little Sioux Scout Ranch in Little Sioux, Iowa. Roughly ninety-five Scouts aged thirteen to eighteen and twenty-five adult staff members were believed to be camping at the time the alarm was raised. Most of the scouts were from Omaha-Metro Area, including Omaha and Bellevue, Nebraska and Council Bluffs, Iowa. It is believed that the scouts had as little as twelve minutes to seek shelter from the time the alarm began to the time the storm hit. Early reports stated that thirty to forty scouts had been injured, that number was later reduced to twenty.

A spokesman for the Boy Scouts of America‘s Mid American Council, the region in which the camp was situated, has stated that the storm activated sirens but she couldn’t confirm whether the scouts were staying in tents or buildings.

The Scouts were participating in a training exercise at the 1,800 acre ranch roughly 40 miles northeast of Omaha. Julie Tack, a spokesperson for Iowa Homeland Security, stated that the camp was littered with debris and downed tree branches after being struck by a tornado at or around 7:00 PM Central Daylight Time. Tack went on to say that a search and rescue team had been deployed to the area.

Camp counselors have stated that they were aware of the possibilities that storm was coming and they had heard the tornado sirens going off. There was no underground shelter for the scouts, however they had shelters designated and emergency plans had been discussed the first day of camp. Officials said most of the boys were on a hike when storms moved in.

A camp staff member said that many scouts were injured when a fireplace in one of the shelters collapsed. Most of the injured scouts were treated at hospitals in Sioux City and Missouri Valley, Iowa. Six scouts were brought to the Missouri Valley hospital, most treated for minor injuries and broken bones. One scout suffered a broken hip and was transferred to Creighton University Medical Center in Omaha.

Mercy Medical Center, in Sioux City, have reported two patients arriving by helicopter at 8:13 PM with a third arriving by ambulance. A fourth patient arrived later, again by helicopter. A spokesman for the hospital said the victims are all juveniles and all have serious injuries. Mercy does not expect to receive more camp victims. The names of the victims have not been released.

Sunday, September 16, 2007

The World Health Organization (WHO), non-governmental aid organisation Médecins Sans Frontières (MSF), and the U.S. Centers for Disease Control and Prevention (CDC) have sent experts to the Democratic Republic of the Congo (DRC) to assist local health authorities with a recent outbreak of Ebola haemorrhagic fever in Kasai Occidental province of DRC. The illness had been unidentified until laboratory test results confirmed the presence of the virus.

DRC President Joseph Kabila described the situation as being contained. “The village of Kampungu has been quarantined to prevent population movement towards Kananga,” Kabila said on Thursday. Kananga is the provincial capital. “The situation is at the moment, I cannot say under control, but at least the problem has been contained very well in the area,” he continued. “There is no risk that the whole country will be affected.”

WHO is working closely with officials from the DRC Ministry of Health and MSF to improve local facilities in order to better contain the virus. A mobile field laboratory is to be established in order to provide rapid sample analysis and, subsequently, diagnosis of patients. There are concurrent outbreaks of other diseases, such as dysentery (Shigellosis), that have been complicating diagnoses and need to be identified as well.

Ebola haemorrhagic fever generates mortality rates in the range of 50 to 90 percent, typically. There is currently no vaccine or effective treatment for Ebola. WHO describes the symptoms of Ebola as being “characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is often followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings show low counts of white blood cells and platelets as well as elevated liver enzymes.”

MSF, who now have 14 experts in DRC, arranged for eighteen tons of supplies, such as medical and sanitation material, to be delivered to the province of West Kasai. MSF indicated that the transportation of supplies from the airport to the affected areas has been a challenge, due to poor road conditions. It has taken up to three days to travel the 250 km to the outbreak area from the provincial capital city, Kananga.

MSF experts will provide advice on sanitary burial procedures, which would include the use of body bags and spraying. Both the WHO and MSF will disseminate information to the local population regarding the transmission of the virus and measures that could be taken to reduce the spread of the disease.

The MSF emergency team coordinator in Kampungu, Rosa Crestani, described the isolation ward set up at Kampungu’s health centre. “Our isolation centre is basically divided in three parts. One is completely isolated, where the sick patients are; another is where the staff dresses with the complete protection uniform and then undresses after having been in contact with the patients; and the third part is a space for disinfection in between,” said Crestani. “In the coming days, we will decide with the Ministry of Health and the WHO whether we set up isolation structures in other locations of the health zone.”

Neighbouring countries, such as Rwanda and Zambia have issued alerts to their citizens, warning of travel to and from DRC. Zambian Health Minister Brian Chituwo stated that all people coming into Zambia from DRC will be watched for symptoms of Ebola for up to eight hours. Chituwo noted, however that it would be unlikely for an infected person to travel into the country, as the time between onset and death is very rapid and that the symptoms are severe.

There has been a minimum of 395 people affected by haemorrhagic fever, including 160 deaths, in DRC in the past few months. Since arriving in Kampungu in early September, MSF have seen 25 patients admitted with suspected Ebola haemorrhagic fever, of which eight have died.

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